On this page
- What Is the ICD-10 Code for Macular Degeneration?
- How Is an AMD Code Built?
- What Are the ICD-10 Codes for Dry Macular Degeneration?
- What Are the ICD-10 Codes for Wet Macular Degeneration?
- How Do You Code AMD in Both Eyes?
- Which Procedures Do AMD Codes Support?
- What Does an AMD Injection Claim Look Like?
- Why Do AMD Claims Deny?
Key takeaways
- Dry macular degeneration is coded H35.31-, and wet macular degeneration is coded H35.32-.
- The 6th character names the eye (1 right, 2 left, 3 both, 9 unspecified), and the 7th character names the stage.
- Dry AMD has 5 stage values (0 to 4), and wet AMD has 4 (0 to 3).
- When one eye is dry and the other is wet, each eye gets its own code.
What Is the ICD-10 Code for Macular Degeneration?
Age-related macular degeneration is coded H35.31- when it is dry (nonexudative) and H35.32- when it is wet (exudative), followed by a character for the eye and a character for the stage. A complete macular degeneration code is always 7 characters long, such as H35.3112.
The codes sit in chapter 7 of ICD-10-CM, under H35, Other retinal disorders. H35.30, unspecified macular degeneration, exists for records that do not name the type, but it carries no eye or stage and rarely supports a test or injection. These codes are part of the wider ophthalmology ICD-10 codes list.
How Is an AMD Code Built?
An AMD code is built in 3 steps, which are the type in the first 5 characters, the eye in the 6th character and the stage in the 7th character. The table breaks down one complete code.
| Part of the code | Characters | Example H35.3221 |
|---|---|---|
| Type | H35.31 dry or H35.32 wet | H35.32, wet AMD |
| Eye | 1 right, 2 left, 3 bilateral, 9 unspecified | 2, left eye |
| Stage | 0 to 4 for dry, 0 to 3 for wet | 1, active choroidal neovascularization |
Without the 7th character the code is a header, not a billable code, and the claim rejects.
What Are the ICD-10 Codes for Dry Macular Degeneration?
Dry macular degeneration codes run from H35.3110 to H35.3194, with the 7th character showing 1 of 5 stages from unspecified to advanced atrophic with subfoveal involvement. The table lists the stage values with a right eye example for each.
| 7th character | Stage | Right eye code |
|---|---|---|
| 0 | Stage unspecified | H35.3110 |
| 1 | Early dry stage | H35.3111 |
| 2 | Intermediate dry stage | H35.3112 |
| 3 | Advanced atrophic without subfoveal involvement | H35.3113 |
| 4 | Advanced atrophic with subfoveal involvement | H35.3114 |
Swap the 6th character for the other eyes. H35.312- is the left eye, H35.313- is both eyes and H35.319- is an unspecified eye.
How do you choose between early and intermediate dry AMD?
The stage follows the exam findings. Early dry AMD usually means small or few medium drusen, and intermediate dry AMD usually means large drusen or pigment changes. The record should name the findings that support the stage chosen.
How is geographic atrophy coded?
Geographic atrophy is the advanced atrophic stage. Use 4 when the atrophy involves the center of the fovea and 3 when it spares the center. This choice matters for the newer geographic atrophy injections, whose coverage lists name these stages.
What Are the ICD-10 Codes for Wet Macular Degeneration?
Wet macular degeneration codes run from H35.3210 to H35.3293, with the 7th character showing whether the choroidal neovascularization is active, inactive or a scar. The table lists each value with a left eye example.
| 7th character | Stage | Left eye code |
|---|---|---|
| 0 | Stage unspecified | H35.3220 |
| 1 | With active choroidal neovascularization | H35.3221 |
| 2 | With inactive choroidal neovascularization | H35.3222 |
| 3 | With inactive scar | H35.3223 |
Active disease shows fluid, hemorrhage or leakage on exam or imaging. Inactive disease shows no current activity, and an inactive scar shows a fibrotic disciform scar.
Which stage applies while a patient is on injections?
The stage follows the findings documented at each visit. Many coders keep the active code while the eye is still receiving anti-VEGF treatment for that disease, but the record must support it. Check the drug's coverage policy, because some list only certain stage values.
How Do You Code AMD in Both Eyes?
Use the bilateral code only when both eyes have the same type and the same stage, and code each eye separately when they differ. These 3 cases cover most patients.
| Findings | Codes |
|---|---|
| Intermediate dry AMD in both eyes | H35.3132 |
| Intermediate dry AMD right eye, early dry AMD left eye | H35.3112 and H35.3121 |
| Intermediate dry AMD right eye, active wet AMD left eye | H35.3112 and H35.3221 |
Separate codes also make it clear which eye supports each procedure line, so an injection in the left eye points to the left eye code.
Which Procedures Do AMD Codes Support?
AMD codes support intravitreal injections, retinal imaging and visits for monitoring, and each service has its own covered diagnosis list. The table pairs common AMD services with their CPT and HCPCS codes.
| Service | Code | Usual AMD diagnosis |
|---|---|---|
| Intravitreal injection | 67028 | H35.32x1 for anti-VEGF, H35.31x3 or H35.31x4 for geographic atrophy drugs |
| Aflibercept 2 mg | J0178, per 1 mg | Wet AMD |
| Aflibercept 8 mg | J0177, per 1 mg | Wet AMD |
| Faricimab | J2777, per 0.1 mg | Wet AMD |
| Ranibizumab | J2778, per 0.1 mg | Wet AMD |
| Pegcetacoplan | J2781 | Geographic atrophy |
| Avacincaptad pegol | J2782 | Geographic atrophy |
| OCT of the retina | 92134 | Dry or wet AMD |
| Fluorescein angiography | 92235 | Suspected or active wet AMD |
Biosimilars carry their own Q codes, and bevacizumab is billed with the code the payer names. Confirm units and covered diagnoses in the current drug policy. Our retina billing services team checks each injection claim against it.
What Does an AMD Injection Claim Look Like?
An AMD injection claim lists the injection, the drug and its units, with each line pointing to the wet AMD code for the treated eye. The example shows aflibercept 2 mg in the right eye with no drug discarded.
| Claim line | Units | Diagnosis |
|---|---|---|
| 67028-RT | 1 | H35.3211, wet AMD, right eye, active |
| J0178-JZ-RT | 2 | H35.3211 |
Medicare requires JZ when no drug from a single-dose vial is discarded, or a JW line for the discarded amount. A visit on the same day needs modifier 25 and its own documented reason.
Why Do AMD Claims Deny?
AMD claims deny most often because the code is missing its stage, names the wrong eye or does not match the drug's covered stages. These checks prevent most of them.
- Full code. Every AMD code has 7 characters.
- Matching eye. The eye in the code matches the RT or LT on the procedure.
- Current stage. The stage matches what the record shows on that date.
- Covered pairing. The code is on the drug or test's covered list.
Our ophthalmology medical coding services review AMD codes, drug units and modifiers on every injection day before the claim is sent.